General Information

About the Tennessee Medical Home Project

In 2012, the Tennessee Chapter of the American Academy of Pediatrics, the Tennessee Department of Health, Family Health and Wellness Division, Children and Youth with Special Health Care Needs (CYSHCN) section, and Family Voices of Tennessee joined forces to create web-based and in-person training resources to support medical providers in building strong medical homes. This series of resources combines the evidence-based strategies of nationally recognized experts in medical home development with local training and resource expertise to provide improvement processes customizable to every practice population or need.

History of Medical Home

Medical Home concepts are intuitive for most pediatricians. As might be expected, the term medical home was first coined by Dr. Calvin Sia and the AAP Council on Pediatric Practice in 1967. Pediatricians realized the children and youth with special healthcare needs (CYSHCN) frequently sought care from multiple venues that were often poorly coordinated. This led to disjointed and redundant service provision. As a result, this initial position statement called for a central repository of medical records for CYSHCN that would reside with the primary care physician and be accessible to all who are involved in the child's care. Thus, the term medical home was initially rooted in a need for better health information technology. (History of the Medical Home Concept, Sia et al).

Current Terminology

The term "medical home" has evolved over time to define a comprehensive approach to whole person care for all children. The AAP policy statement from 2009 states that

"...medical care of infants, children, and adolescents ideally should be accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care." (AAP Policy statement, The Medical Home)

The concept has generalized to the broader medical community and is now recognized in the Joint Principles of Medical Home published by the American Academy of Family Physicians (AAFP), American Academy of Pediatrics (AAP), American College of Physicians (ACP), and American Osteopathic Association (AOA) in 2007. (Joint Principles of the Patient Centered Medical Home, March 2007) While unique features of medical home definitions endorsed by different organizations persist, the core concepts of medical home are rapidly becoming the rubric by which practices are measured and provider payments are provided.

Implementation

Medical Home provision, and in particular care coordination provision, has been linked with decreased utilization of high cost services, reflecting better health and controlled costs. Improved medical home provision has also been linked with reduction in health disparities and improved physician and staff satisfaction. (Literature Links to Impact of Medical Home) Despite the benefits demonstrated in practices implementing medical home concepts, only 46% of children and youth with special healthcare needs (CYSHCN) in Tennessee report they have access to a medical home, and 10% of these high risk children report they have no usual source of care. (2009/10 National Survey of Children with Special HealthCare Needs Medical Home State Profile.

These deficiencies are mirrored in surveys of family and youth across the country. As a result, improving medical home access for children and youth is a priority in the Healthy People 2020 objectives for improving health of Americans.